Background & Aims:
Diagnostic procedures in Whipple's disease usually focus on the intestine, but symptomatic central nervous system involvement is a major threat for patients. The aim of this study was to determine the diagnostic value of cerebrospinal fluid (CSF) analysis.
Methods:
A total of 39 CSF samples and two brain biopsy specimens were examined, obtained from 24 patients with Whipple's disease at various intervals after diagnosis. Five patients presented with neurological symptoms, three of them as relapses under therapy. Thirty-two CSF samples were examined by polymerase chain reaction (PCR) for
Tropheryma whippelii, and 20 CSF samples by cytology. Brain biopsies were examined histologically.
Results: Positive results were obtained in four of five patients (80%) with
neurological symptoms, but also in seven of ten patients (70%) without neurological symptoms examined prior to therapy, and in three of eleven patients (27%) without neurological symptoms studied during or
after therapy. Conversion from positive to negative was observed in four patients after antibiotic treatment.
Conclusions: Testing of CSF in Whipple's disease yields a high rate of
positive results, even in patients without neurological symptoms. Examination of CSF is therefore potentially useful for initial staging and for monitoring of the efficiency of therapy.
